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PubMed1995

Abortions in rural Idaho: physicians' attitudes and practices.

This study surveyed all family physicians, obstetrician-gynecologists, and general surgeons practicing in rural Idaho in 1994. Although most respondents provided a wide range of reproductive health services, less than 4% performed abortions, so most rural Idaho women wanting abortions must travel long distances for this procedure. Physicians report that they do not provide abortion services because of both their own moral objections and local community opposition to the procedure. Yet 26% of the respondents indicated interest in using RU-486 for abortions when it becomes available. This suggests that the development of acceptable medical abortifacients may improve access to this procedure even in very conservative rural areas.

Abortifacient Agents, Steroidal↗
PubMed2002

Voluntary health workers' knowledge, attitude and practices regarding record keeping in Akinyele LGA of Oyo State, Nigeria.

Lack of basic health data for monitoring and evaluation of health services continue to affect the planning, implementation and evaluation of health services in Nigeria. This has contributed to the poor health status and inefficient health services in the country. In the primary health care management information system (PHCMIS), Voluntary Village Health Workers (VHWs) and Traditional Birth Attendants (TBAs) are responsible for collecting information at the community/village level. Trained research assistants administered a pretested semi structured questionnaire and filled an observation checklist to all the voluntary health workers in Akinyele LGA of Oyo State in a cross-sectional survey conducted to assess their record keeping practices as well as their knowledge of and attitude towards it. Results showed that almost half of the respondents had no formal education and a similar proportion had been VHWs for between over 10 years. Over eighty per cent knew the uses of record keeping for monitoring and evaluation purposes. Their attitude towards it was positive and almost all felt it was easy to keep records. Ninety six percent keep records of their health activities and most forward them. It was observed that only 11 (10.8%) respondents had the VHW/TBA record of work produced and recommended by the Federal Ministry of Health because they were reportedly not supplied to them. The factors that were associated with record keeping practices were positive attitude towards record keeping, duration of work as a VHW/TBA, prior training on record keeping and receiving feedback on records kept. Recommendations made included periodic training and retraining of the VHWs on record keeping, ensuring consistent supply of record forms and providing regular feedback on records kept to the VHWs.

Adult↗
PubMed2006

New Zealand health professionals do not agree about what defines appropriate attendance at an emergency department.

AIMS: Emergency Departments (EDs) worldwide are facing a crisis from overcrowding--a common perception exists that inappropriate use of the ED is the major contributing factor. This study aims to examine the concept of 'inappropriate' ED attendances in relation to the Emergency Department at New Zealand's Christchurch Hospital. It specifically seeks to determine whether there is a consensus opinion among healthcare providers regarding a definition of 'inappropriate'. METHODS: An exploratory survey of health professionals involved with the referral, assessment, transport, and treatment of ED patients in Christchurch was carried out. A range of health professionals, including ambulance personnel, general practitioners, emergency department physicians, emergency nurses, and hospital managers were approached. A series of questions relating to definition and response to 'inappropriate' patients was asked, with an additional open-ended question relating to the definition of 'appropriateness'. RESULTS: There are significant differences in the attitudes and perceptions of key health professionals involved in the referral, treatment, and admission of patients to the ED. CONCLUSIONS: While there are some areas of general agreement, there is no clear consensus between the professionals surveyed regarding the concept of 'appropriateness.' This has implications for any interventions aimed at addressing ED 'overcrowding' that assume the presence of a consensus understanding of this concept.

Adult↗
PubMedDate not supplied

Diffusion of the U.S. Preventive Services Task Force recommendations into practice.

The U.S. Preventive Services Task Force's "Guide to Clinical Preventive Services" summarizes the results of a critical review of the literature pertaining to the effectiveness of 169 interventions in modifying 60 risk factors or conditions. The ultimate impact of the guide depends on the diffusion into clinical practice of its recommendations. This report reviews the factors influencing the diffusion process. Three categories of behavioral influence--predisposing, enabling, and reinforcing factors--apply to this diffusion process. Predisposing factors include knowledge and attitudes, personal health behaviors, confidence, and beliefs about patients' interests in health-promotion advice. Enabling factors include competence to perform preventive services, reimbursement for preventive services, organization of the practice setting, time to provide preventive services, a reminder system, and a coherent set of guidelines that are perceived as scientific and unambiguous. Reinforcing factors include peer support, feedback, evidence of results, and an enhanced sense of self-efficacy in fulfilling one's role as a healer. Recommendations are given for using these factors to increase the diffusion of preventive services into clinical practice.

Diffusion of Innovation↗
PubMed2006

[The development of a dementia knowledge test for general practitioners].

There is no test available to measure German GPs' knowledge of dementia. Existing English questionnaires cannot be transferred to the German setting and do not focus on the GPs' specific problems and tasks. The management of dementia patients and their relatives both involves psychiatric and GP expertise. Therefore, we asked psychiatrists with a specialty in geriatric psychiatry and experienced GPs to assess 59 multiple-choice questions. The concordance of responses in each expert group and for each question, their ratings of relevance for the GPs' situation on a sixtier scale and their comments on each question served as the basis for the selection of the final 37 items concerning 11 dementia subjects. After pilot testing has been completed, this set of questions will be sent to GPs in three German regions in an attempt to get a general idea of German GPs' knowledge of dementia and to analyze the psychometric properties of the test.

Activities of Daily Living↗
PubMed1989

[Awareness of oral health in 45 to 54-year old Berlin subjects and correlation with clinical periodontal findings].

143 subjects 45-54 years old were interviewed by questionnaire about their oral hygiene behaviour, their knowledge about periodontal diseases and their opinion concerning prophylaxis and therapy of periodontitis. The CPITN and the loss of attachment was measured at each tooth by clinical examination. Then the clinical data were examined for possible correlation to socioeconomic factors, gender or behaviour and knowledge of the subjects. Women showed statistically significant better clinical data than men, but no correlation to CPITN classes was found in analyzing education, profession or income. Also clinical data could not be found influenced by the frequency of toothbrushing and frequency of seeing a dentist or by the patients knowledge. However, increasing knowledge about their disease significantly increased the subjects willingness to undergo a long-term treatment. The subjects examined were interested in oral health, but their clinical data indicated that motivation or knowledge was not converted sufficiently into practice.

Attitude to Health↗
PubMed1992

Knowledge, attitudes and practices of Greek health professionals, in relation to AIDS.

In order to improve educational programmes directed at health care workers we investigated their knowledge, attitudes and practices in relation to HIV/AIDS. An anonymous self-administered questionnaires was distributed to 609 health care workers. Of these, 59.6% agreed to participate (42.4% of the medical doctors, 74.3% of the nurses and 79.6% of the laboratory technicians, health visitors and other health care workers). All studied groups believed that their knowledge of HIV modes of transmission (84.3%) was sufficient. In contrast, a relatively small percentage reported knowledge of the clinical spectrum of HIV infection (48.8%) and the diagnostic assays (57.6%). Nearly all the study participants believe (92.8%) that there is a risk of acquiring HIV infection during the hospitalization of HIV/AIDS patients. Obligatory screening of all patients was reported by nearly all participants (90.6%) as a chance to minimize their occupational risk. Although health care workers reported satisfactory knowledge of safety measures (87.0%), only 56.7% used gloves and 38.8% accept the hospitalization of HIV/AIDS patients. In spite of the educational programmes for AIDS in Greece, this study demonstrates that health professionals' knowledge and precautionary measures are not sufficient. As a result, a small percentage of them treat AIDS patients without discrimination. There is an urgent need to implement specific educational programmes for health professionals so that they will safely provide high quality care to people affected by HIV/AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Physicians' oral health education in Kentucky.

OBJECTIVES: The Physicians' Oral Health Education in Kentucky (POHEK) curriculum was developed to teach family medicine residents to (1) perform oral health screening and risk assessment and (2) recognize and manage common oral conditions for children ages 5 years and under. METHODS: Family medicine residents in urban and rural settings received didactics and hands-on experience providing oral screening, risk assessments, and counseling for their pediatric patients. EVALUATION: Residents were evaluated by comparing pretest and posttest means of surveys that assessed attitudes and knowledge. Chart audits were also performed. CONCLUSIONS: Residents' knowledge and attitudes improved in the oral health care of their pediatric patients.

Attitude of Health Personnel↗
PubMed1996

General practitioners and clinical guidelines: a survey of knowledge, use and beliefs.

BACKGROUND: Clinical practice guidelines are being developed for a variety of reasons. To date, there has been little investigation of the perspectives of those who are recommended to use them. AIM: The survey reported here set out to investigate how familiar general practitioners are with a range of published guidelines, to assess whether they have used them, and to describe their attitudes to the guidelines and the methods of implementing them. METHOD: A postal questionnaire was sent to a random sample of 559 general practitioners in the North and Yorkshire region in March 1995. Questions were organized around the topics of: knowledge; use; practice change; beliefs; pressure felt to use the guidelines; and methods of implementation. Basic classificatory data on gender; year of qualification; partnership and fundholding status were also collected. RESULTS: Replies were received from 300 doctors (54%). Knowledge and use of the three selected guidelines varied, but was generally towards the 'high' end of the scale. Doctors showed a high degree of homogeneity in their attitudes to guidelines, which were generally positive. Only single-handed practitioners varied from this pattern of responses. Most of the pressure to use the guidelines was felt to come from the Department of Health, and the least pressure from patients. Doctors felt that the methods of implementation that involved them in educational events and discussion with colleagues were most likely to have an impact on them. CONCLUSION: General practitioners are receptive to guideline initiatives, and their views are in line with existing or proposed implementation strategies. More investigation of the concept of 'use' is needed.

Attitude of Health Personnel↗
PubMed1997

Asthma education for Swedish primary care physicians--a study on the effects of "academic detailing" on practice and patient knowledge.

OBJECTIVE: To assess the effect of an intervention on general practitioners' (GPs) knowledge about the diagnosis and treatment of asthma, including the prescribing of anti-asthmatic drugs, and asthmatic patients' knowledge about their disease. METHODS: The study took place in the south-west region of Stockholm County. In the area where the intervention took place (area 1), 44 GPs at 21 health centres were visited by a clinical pharmacologist and a pharmacist presenting oral and written information. The basic messages were: (1) the central role of inhaled glucocorticoids; (2) the use of peak expiratory flow (PEF) meters; and (3) the use of reversibility tests. In the control area (area 2), there were 19 GPs at nine health centres. The GPs knowledge about the intervention message was evaluated by a questionnaire pre- and post-intervention. The ratios of prescribed inhaled be beta-adrenoceptor agonists to inhaled glucocorticoids were determined. At the 26 local pharmacies, all asthmatic patients who presented a prescription for anti-asthmatic drugs, issued at the 30 health centres, were given a questionnaire before and after the intervention regarding their knowledge of asthma and its treatment. RESULTS: GPs in area 1 showed significantly more knowledge about item numbers 2 and 3 in the above-described intervention message than did the GPs in the control area 2. The data on prescriptions showed lower ratios of beta-adrenoceptor agonists to glucocorticoids in area 1 than in area 2. The difference, however, between area 1 and area 2 was not significant. After the GP intervention, the patients' knowledge about asthma had increased in area 1, as assessed by the questionnaire filled in by the patients. However, there was no significant difference from that in area 2. CONCLUSIONS: The study shows differences between the intervention and control areas regarding the knowledge and practice of GPs after the intervention. We found changes in knowledge, attitudes and actual practice, the latter being measured by the prescriptions.

Asthma↗
PubMed2003

Incorporating socio-political health promotion activities in clinical practice.

A criticism laid at the door of many nurses in relation to their health promotion activity is that they almost exclusively adopt a biomedical/preventative health education approach. When it comes to adopting socio-political health promotion approaches, there is scant evidence that nurses implement these activities in clinical practice. This article is designed to raise awareness and signpost the types of activities that nurses could be involved with if they wish to influence the broader social and political health promotion agenda. In doing so, it has developed an 'effect' programme model for socio-political health promotion practice as a framework for those practitioners who wish to review their current health-related activities and/or who are seeking to extend their range of health promotional practice. This article draws upon a critical review of the literature in order to develop an evolving theoretical perspective for health promotion practice. The proposed model was developed from this new perspective as were recommendations for practice.

Health Behavior↗
PubMed2004

Cardiovascular risk factors and motivation for a healthy life-style in a German community--results of the GP-based Oestringen study.

This paper explores the motivation of patients towards a healthy life-style in a small community with a special general practice and community-based health education program in order to identify reasons for different motivations and barriers and to improve preventive measures and outcome. The last of six standardised health surveys carried out over 9 years in the five general practices was therefore combined with a questionnaire to explore the attitudes of a sample of patients from these practices (N = 1044) and all attendees of 11 health education courses (N = 153). In addition to the cardiovascular risk factors, data were collected on sociodemographic factors and motivations for health promotion. The results show that, over time, the risk factors of hypertension (P < 0.001) and smoking (P < 0.005) had decreased. Health-promoting activities were not associated with cardiovascular risk factors; the motivations "duty" and "staying young" correlated with gender (P < 0.05). Patients with good health and white collar professions were more active. About 20% specified specific barriers to health-related activities. As expected, the participants of an educational program were more highly motivated by "fun", "fitness" and "meaningfulness". This group was mainly female. Future preventive measures should take into account that motivation for health promotion depends more on psychosocial factors than on risk factors; frequent obstacles should be noticed in the community.

Attitude to Health↗
PubMed2003

Rural secondary school students living in a small community: their attitudes, beliefs and perceptions towards general practice.

OBJECTIVE: To study the attitudes and beliefs towards general practice of rural secondary school students, in particular, their perception of the barriers to the effective delivery of primary health care. SETTING: Students attending a government-funded secondary school in a rural community of less than 4000 people. SUBJECTS: 250 students in years 7-12 were surveyed, with 177 (71%) replying, 45% of these being male. DESIGN: Cross-sectional, self-administered questionnaire survey. RESULTS: The study found that most students value general practitioners (GPs) as valuable sources of health care, feel they have reasonable access to care and in most instances appear to attend appropriately for their health problems. Most felt their doctor would be an empathetic listener, would provide sufficient time to provide effective care and communicated in a language they could understand. Confidentiality issues were considered important, especially by females. CONCLUSION: Although students have very positive attitudes about general practice, the findings could be used to improve a number of GP services for young people in small rural communities. This is particularly so for presentations which require a high degree of confidentiality and skillful counselling, such as psychological problems and risk-taking behaviours.

Adolescent↗
PubMed2002

The home management and characteristics of children presenting to hospital with acute gastroenteritis.

Large numbers of Australian children are admitted to hospital with acute gastroenteritis. This study aimed to describe the home management of children with acute gastroenteritis prior to presentation at a paediatric hospital. Parents received inadequate information regarding fluid rehydration, particularly from general practitioners, and there was a lack of parental awareness in relation to ORS usage. Children attending childcare were over represented among the sample. The majority of children were only mildly dehydrate presentation to hospital. Education programs are needed to increase community awareness ORS and improve home management of acute gastroenteritis.

Acute Disease↗
PubMed1990

Effect of a geriatric educational experience on graduates activities and attitudes.

Clinical geriatric dentistry has not been an important part of most dental curricula. However, changes in demographic and patient expectations signify that geriatric oral health care can no longer be equated with supplying dentures for an aging population, but must be understood as treatment of the complex needs of a dentate population. The 1975 to 1985 graduates of the University of Iowa College of Dentistry were surveyed to evaluate the influence on dental practice of a comprehensive geriatric dental curriculum introduced in 1980. The post-1980 graduates were more likely to be practicing in larger population centers and less likely to be treating patients over 75 years of age. The dentists who graduated before 1980 were more likely to be consultants in nursing homes and carrying out examination, emergency care, and/or denture care, whereas the group of dentists who graduated after 1980 and had geriatric clinical experience with frail and functionally dependent older adults were more likely to be carrying out comprehensive care. When given a list of 18 geriatric dental and gerontological topics, few differences were found between cohort groups in terms of knowledge and confidence in carrying out procedures.

Cohort Studies↗
PubMed2004

Low literacy Chinese patients: how are they affected and how do they cope with health matters? A qualitative study.

BACKGROUND: Low literacy is common in Hong Kong and China, especially among the females and the elderly. These are often the patients with the greatest health care needs. However little is known about how low literacy affects the ability of patients to obtain adequate medical care and comply with the recommendations of health professionals. METHODS: Qualitative study of subjects' opinions using semi-structured group and individual interviews. Thirty-six participants took part in 6 group and 9 individual interviews. RESULTS: Participants' opinions towards low literacy were explored in the interviews. They expressed diverse views on how they perceived low literacy. Some thought they were handicapped by it but others felt it was not a problem. Age, gender, chronic illnesses and their attitudes towards self were found to be major factors affecting their perception. Despite their low literacy, some had their specific ways to overcome the difficulties, for example, drawing symbols to help with the timing of taking the medications. Most of them felt better explanation by the health care workers was most important. CONCLUSIONS: It is highly relevant for health care workers to be aware of the low literacy status of their patients and to explain information so that patients understand it.

Adaptation, Psychological↗